2014_0730_RPZ (3) C�IECK ONE:
IRRIGATION DOMESTIC FIRELINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAI�OF PWS: CITY OF COPPELL
PWS I.D. #
LOCATION OF SERVICE:S7: /�1��-9r► 17/?E r���/>.��,h�.� �"'��d �/� ���►e y
The bacl�low prevmtion asscmbly decaile� below has beea tested aad ma�ntain� � nq�� bv TNRCC
regulauons aad is cerdfie�to be operating within acceptable paramctcrs.
' TYPE OF ASSEMBLY
� Raiuced Pressure Principle C Pressurc Vacu�Breaker
� Double Chcck Valve � Atmosphere Vacuum Breaker
it
Maaufactsaer �;��i4 ��"S Siu �
Model Iv�ber t�t�'��J�'� «� Located At �I SC'.Y l'D�J��i�J1''�3
Serial Nimmber ��/� ��
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAI�R
Double Check Valve Assembly
lst Check 2nd Checl: ReIief Valve Air Inlet Check Valve
Inival Test DGClosed Closed Ti;ht �' Opened at Opened at osid
Tighf Leal:ed o `7��Dsid _osid
RP- �� sid �,�
Leal:ed o Did aot Opea o Leal:ed ❑
RePairs
and
Materials
Used
Test ARer DC-Closed Closed Tight o Opened at ppeaod at _�sid
Repair Tight ❑ �Dsid __osid
RP sid
The above is certified to be true.
Firm Name��r�v �ir�1h Catified Testa �-k'..r�uti�/E�U�
F�Aaa�P� �z���r ����;,�Tx�i��9 c«t. r�xo�i����G9 D� ��
cauge # ���Q�/!J� S�
llate last accuracy tested ����
White- Customer's Copy Yellow - City Copy Pink-Tester's Copy